1. < Prostate Cancer

Detection and treatment of microscopic cancer cells

Posted by robertkerr @robertkerr, Oct 7, 2022

I had a robotic prostatectomy back in 2015 for PT3b Gleason 9 disease with intraductal carcinoma. I had salvage radiotherapy in 2019. I was diagnosed with oesophageal cancer end 2020 which was treated with an esophagectomy & 24 weeks of Xelox chemo.

My psa dropped to 0.039 but 6 months after my chemotherapy finished, increased to 0.30. In the last 2 months it has increased to 0.7. I have had a PSMA PET CT scan and an FDG PET CT scan which showed nil cancer. I believe the cancer cells may be microscopic and undetectable by the scans.
Is there any way of detecting microscopic cancer cells and any treatment for them as they could be all over my body ?
I would welcome any advice. Thanks

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kujhawk1978 | @kujhawk1978 | Oct 8, 2022

While significant advances in imaging for prostate cancer have been made, and continue to be made, there is a limit to what can be detected. Keep in mind a negative image may not mean no PCa, there can be micro-metastatic PCa (see the attached chart).

There are tests for "Circulating Tumor Cells" which you can discuss with your medical team, here's one link - https://www.cellsearchctc.com/about-cellsearch/what-is-cellsearch-ctc-test#:~:text=The%20CELLSEARCH%C2%AE%20CTC%20Test%20is%20a%20simple%2C%20actionable%20blood,circulating%20tumor%20cells%20(CTCs).

The question you have to ask yourself is if the imaging shows where the PCA is, does it change your treatment decision?

Here's an article about imaging - https://www.prostatecancer.news/2016/12/pet-scans-for-prostate-cancer.html

Some decisions to think about:

Continue to actively monitor, have a decision point about when to image again, PSA >1, 2...Certainly if you are considering radiation, knowing where the PCA is can be use in building a treatment plan with boosts to the sites and wider treatment field margins around them

If you feel based on your clinical history to date that you need to start treatment now (with those PSA results, I would not, see my clinical history in the chart I attached), then doublet or triplet therapy may be feasible options.

Kevin
REPLY
3 replies
nyharvey | @nyharvey | Oct 8, 2022

Mayo Clinic is tremendous. But if geography puts you closer to Mass General/Dana Farber, try that place. I'm sure Mayo Clinic and Dana Farber would collaborate.

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kepasa | @kepasa | Oct 8, 2022
In reply to @vjlvpjalways "Are you continuing on ADT?" + (show)
@vjlvpjalways

Are you continuing on ADT?

Jump to this post

Had radical prostectomy only , removed 10 pelvic lymph nodes and seminal vesicles, , no additional treatment was deemed necessary by urologic oncology team , inspite of my requests both pre surgically and post by 2 separate urologists and head of urologic oncology at a University cancer center . The request was skirted if you will. Now PSA is below FDA guidelines for PSMA GALLIUM OR PALARIFY PET SCAN
I am in a box of sorts. The aggreesive nature of my diagnosis was stressed over and over by all medical professionsls involved. Both before and after RP.
I am at a loss as to rationale

REPLY
kepasa | @kepasa | Oct 8, 2022
In reply to @kujhawk1978 "While significant advances in imaging for prostate cancer have been made, and continue to be made,..." + (show)
@kujhawk1978

While significant advances in imaging for prostate cancer have been made, and continue to be made, there is a limit to what can be detected. Keep in mind a negative image may not mean no PCa, there can be micro-metastatic PCa (see the attached chart).

There are tests for "Circulating Tumor Cells" which you can discuss with your medical team, here's one link - https://www.cellsearchctc.com/about-cellsearch/what-is-cellsearch-ctc-test#:~:text=The%20CELLSEARCH%C2%AE%20CTC%20Test%20is%20a%20simple%2C%20actionable%20blood,circulating%20tumor%20cells%20(CTCs).

The question you have to ask yourself is if the imaging shows where the PCA is, does it change your treatment decision?

Here's an article about imaging - https://www.prostatecancer.news/2016/12/pet-scans-for-prostate-cancer.html

Some decisions to think about:

Continue to actively monitor, have a decision point about when to image again, PSA >1, 2...Certainly if you are considering radiation, knowing where the PCA is can be use in building a treatment plan with boosts to the sites and wider treatment field margins around them

If you feel based on your clinical history to date that you need to start treatment now (with those PSA results, I would not, see my clinical history in the chart I attached), then doublet or triplet therapy may be feasible options.

Kevin

Jump to this post

Very interesting charts, thanks

REPLY
kepasa | @kepasa | Oct 8, 2022
In reply to @kujhawk1978 "While significant advances in imaging for prostate cancer have been made, and continue to be made,..." + (show)
@kujhawk1978

While significant advances in imaging for prostate cancer have been made, and continue to be made, there is a limit to what can be detected. Keep in mind a negative image may not mean no PCa, there can be micro-metastatic PCa (see the attached chart).

There are tests for "Circulating Tumor Cells" which you can discuss with your medical team, here's one link - https://www.cellsearchctc.com/about-cellsearch/what-is-cellsearch-ctc-test#:~:text=The%20CELLSEARCH%C2%AE%20CTC%20Test%20is%20a%20simple%2C%20actionable%20blood,circulating%20tumor%20cells%20(CTCs).

The question you have to ask yourself is if the imaging shows where the PCA is, does it change your treatment decision?

Here's an article about imaging - https://www.prostatecancer.news/2016/12/pet-scans-for-prostate-cancer.html

Some decisions to think about:

Continue to actively monitor, have a decision point about when to image again, PSA >1, 2...Certainly if you are considering radiation, knowing where the PCA is can be use in building a treatment plan with boosts to the sites and wider treatment field margins around them

If you feel based on your clinical history to date that you need to start treatment now (with those PSA results, I would not, see my clinical history in the chart I attached), then doublet or triplet therapy may be feasible options.

Kevin

Jump to this post

Very interesting charts.
Thank for sharing sincerely

REPLY
robertkerr | @robertkerr | Oct 9, 2022
In reply to @vjlvpjalways "Are you continuing on ADT?" + (show)
@vjlvpjalways

Are you continuing on ADT?

Jump to this post

I am not on ADT and am having no treatment for prostrate cancer at present other than Lyrica to treat the neuropathy following the chemo for the cancer of the oesophagus.

REPLY
robertkerr | @robertkerr | Oct 9, 2022
In reply to @kujhawk1978 "While significant advances in imaging for prostate cancer have been made, and continue to be made,..." + (show)
@kujhawk1978

While significant advances in imaging for prostate cancer have been made, and continue to be made, there is a limit to what can be detected. Keep in mind a negative image may not mean no PCa, there can be micro-metastatic PCa (see the attached chart).

There are tests for "Circulating Tumor Cells" which you can discuss with your medical team, here's one link - https://www.cellsearchctc.com/about-cellsearch/what-is-cellsearch-ctc-test#:~:text=The%20CELLSEARCH%C2%AE%20CTC%20Test%20is%20a%20simple%2C%20actionable%20blood,circulating%20tumor%20cells%20(CTCs).

The question you have to ask yourself is if the imaging shows where the PCA is, does it change your treatment decision?

Here's an article about imaging - https://www.prostatecancer.news/2016/12/pet-scans-for-prostate-cancer.html

Some decisions to think about:

Continue to actively monitor, have a decision point about when to image again, PSA >1, 2...Certainly if you are considering radiation, knowing where the PCA is can be use in building a treatment plan with boosts to the sites and wider treatment field margins around them

If you feel based on your clinical history to date that you need to start treatment now (with those PSA results, I would not, see my clinical history in the chart I attached), then doublet or triplet therapy may be feasible options.

Kevin

Jump to this post

Thanks for your advice. I am inclined to wait until the PSA gets to the 2.0 or above and then arrange a PSMA PET CT scan. I am seeing my oncologist on 12th October and will discuss ADT, doublet or triplet therapy options.

REPLY
2 replies
vjlvpjalways | @vjlvpjalways | Oct 9, 2022
In reply to @robertkerr "Thanks for your advice. I am inclined to wait until the PSA gets to the 2.0..." + (show)
@robertkerr

Thanks for your advice. I am inclined to wait until the PSA gets to the 2.0 or above and then arrange a PSMA PET CT scan. I am seeing my oncologist on 12th October and will discuss ADT, doublet or triplet therapy options.

Jump to this post

I think the question I should have asked did you do ADT along with your salvage radiation?

REPLY
robertkerr | @robertkerr | Oct 9, 2022

Yes - I did do ADT along with salvage radiation in 2019. My RT specialist copied the SPPORT trial by Dr Pollack ( University of Miami) which involved the 33 radiation sessions and 2 times 3 monthly injections of Lucrin.
The last published trial results in October 2018 showed an 89% success rate after 5 years.

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